For this physical therapy newsletter, I picked a broad topic, and I will therefore be brief and discuss only a few of the most common misconceptions and misunderstandings that we hear. Quite often, even physical therapists, physicians and other health care professionals add to this confusion by providing conflicting recommendations. As a disclaimer, I’d like to add that stated “facts” below are based on the best research evidence available today, which may be challenged by future research.

Myth: Physical therapists should follow the motto “no pain, no gain”.

Fact: Although regaining mobility after certain surgeries and conditions such as frozen shoulder may cause some pain, it is typically counter productive to cause pain with rehabilitation. Pain leads to a reflex contraction of certain muscles, which in turn increases the pain further, in a viscous cycle. If there is swelling and inflammation present, increased pain may even trigger the formation of additional scar tissue, which could jeopardize future recovery of mobility and function. It is therefore more productive for the physical therapist to inhibit pain and muscle guarding through specific manual therapy treatment and specifically designed exercise.

Myth: To build strong abdominal muscles, I need to exercise daily, and do many repetitions.

Fact: Abdominal muscles respond to exercise the same way as other skeletal muscles. To build muscle strength and size, you don’t want to train the same muscle more than every other day. If you do 50-100 “crunches”, you are not getting nearly as strong and defined, as if you did 15-20 isolated slow repetitions, to muscle fatigue.

Myth: I got hurt because I didn’t stretch.

Fact: Although gentle muscle stretching performed after a thorough warm-up is a recommended method before any high intensity or explosive sports activity, there is today very little evidence that muscle stretching can prevent injuries. In past newsletters, I have written about evidence that stretching can cause muscle damage, e.g. chronic hamstring muscle strains in dancers. However, the warm-up process is essential, which entails repeatedly contracting muscles to increase the blood circulation within the muscle, increase connective tissue elasticity, and increase the intramuscular metabolism.

Myth: The best way to recover from a muscle strain is to stretch the muscle.

Fact: Although athletes are often told by trainers and coaches (and even physical therapists and physicians) to start stretching the strained muscle after a week or so, this is almost a certain way to prolong and complicate the healing. After a muscle has been strained, it does not at first have sufficient tensile strength to handle a passive stretch, which often re-tears new fragile fibers formed in the muscle, resulting in additional micro trauma and inflammation. Instead, the muscle needs to be carefully contracted with exercise, at first with low intensity and without stretch, and gradually progressed to higher intensity work, and eventually even from a stretched position. If done correctly, even severe muscle strains can typically heal in four weeks.

Myth: Applying heat will increase the circulation in the area and therefore help the healing.

Fact: Heat will open up (vasodilate) blood vessels and bring fluid to the area, however it will not remove fluids or circulate the blood. This can be done only by contracting muscles to active the venolymphatic pump. Consequently, if there is some degree of inflammation present, applying heat may only cause pooling and stagnation of fluids in the area, which can slow down the healing.